Acid Base Case Study

8/16/2019 Acid Base Case Study

1/4

CASE STUDY:

A Father’s Perspective:

“When we were first told about that it could possibly be biliary atresia we really did not

understand the full ramifications of the disease We were ob!iously saddened by the news" but#ept hope that it was not the case When it was officially dia$nosed at % month of a$e" & thin# we

went throu$h all classic symptoms when dealin$ with somethin$ so tra$ic'

Denial( after all the odds were %:%)"***(+*"***

Confusion( what actually is wron$, Why did it happen,

Frustration( not #nowin$ e-actly what was $oin$ on and bein$ shuffled from Dr to Dr"

hospital to hospital

Anger( why did this happen to us, Did somethin$ in the hospital happen to cause this,

Acceptance- this is real and now we must do whate!er we can to help her

&t preyed on our minds day and ni$ht .still does/" but we ha!e learned so much since the be$innin$ and now it is simply part of our “normal0 e!eryday life0

Patient Information:

The patient is a full(term female to a 1%(year(old 234+ 4re$nancy was without complicationsSe!eral prenatal ultrasounds were normal per the mother5s report" and there was no e!idence of

intrauterine infections The birth wei$ht was 6 lb + o7 There were no complications durin$ the

deli!ery 8aundice and clay(colored stool were noticed at two days of life The patient was

started on Acti$all and 4henobarbital for the presumed dia$nosis of nonsyndromic or syndromic bile duct paucity durin$ the first wee# of life

The initial wor#up included: C9(urine anti$en and urine or$anic acids The patient wasdischar$ed home on day of life %* 8aundice and acholic stools persisted A ;&DA scan showeddecreased e-cretion" and the patient underwent an intra(operati!e cholan$io$ram one month

later Accordin$ to the parents" an atrophic $allbladder and failure of pro$ression of contrast into

the intra(hepatic bile ducts were noticed ( consistent with biliary atresia The patient underwentaundice resol!ed fairly soonThe patient was dischar$ed on a prednisone taper and discontinued 3 months later

The patient was admitted twice because of presumed cholan$itis" within one month of the


2/4

pi$mented ;owe!er" two days after the dischar$e" the parents noticed recurrence of clay(

colored stool which was accompanied by the acute onset of >aundice The first day the total

bilirubin was )6 and the ne-t the total bilirubin was ??

9edications at the time were: Acti$all" % ml .re(started " prior had been stopped/ 4@ &D"

ADEaundiced" with sclera icterus 9ucous membranes are moist Chest is clear to

auscultation @n cardio!ascular e-am" heart rate was re$ular without murmurs Abdomen is

soft The incision site of the


3/4

&n summary" the patient is now a 1(month(old female with biliary atresia status post aundice consistent with restoration of bile flow Theacute recurrence of acholic stools and >aundice indicate either infectious or inflammatory

obstruction of the drainin$ bile ducts at the site of the porto( enterostomy

The patient was hospitali7ed" recei!ed & pulse (dosin$ corticosteroids which did not impro!eher symptoms" and therefore underwent a re(e-ploration of her aundice" coa$ulopathy" and ascites She is currently listed for a li!er transplant

Nursing Care Plan:

Examples of Nursing Assessment:

These are a few e-amples of characteristics to monitor: stool color" ascites" peripheral edema"

hepatoKsplenome$aly" anore-ia" urine color" lethar$y" >aundice" bleedin$" pruritus" !ital si$ns"

si$ns of dehydration" and wei$ht

Nursing care plan:

1. Nursing diagnosis: fluid !olume deficit rKt poor absorption

Plan: maintain fluid and electrolyte balance

Interventions: document and monitor :inta#e and output" specific $ra!ity" daily wei$hts" dailyabdominal $irth measurements" assess for si$ns of dehydration" assess for fluid o!erload" chec#

!itals" monitor for si$ns of tachycardia or new murmurs"

Chec# laboratory studies for electrolyte imbalances"

Capillary refill less than 3 seconds and urine output valuation: Chart abo!e information" be able to identify and report abnormalities and reassess

!. Nursing Diagnosis: 4otential for altered $rowth(due to li!er disease

Plan: &nfantK child $row followin$ $rowth cur!e while maintainin$ appropriate nutritional status

Interventions: 9onitor $rowth cur!e( monitor wei$ht on re$ular basis

Assure that ADE< !itamins ta#en on re$ular basis" monitor lab !alues&nstruct re$ardin$ methods to increase calories: medium chain tri$lyceride formula" additional

formula supplementation

!. Nursing Diagnosis: Altered 2rowth and De!elopment rKt chronic illness

Plan: infantKchild will de!elop accordin$ to de!elopmental milestones $uidelines

Intervention: 4hysical therapy" occupational therapy" early inter!ention pro$rams" parentclasses" and support $roups 4romote acti!ities to meet de!elopmental milestones includin$

!erbal" auditory" tactile and !isual stimulation

valuation: assess ran$e of motion" $ross and fine motor s#ills.Speer" %GG*/

". Nursing Diagnosis:


4/4

Plan: 4arents understand home care instructions

Intervention e#amples: Teach parents about medications includin$ purpose" dose"

administration" side effects and si$ns and symptoms to report Teach parents importance ofcompliance relatin$ to testin$" medications and follow(up !isits Teach parents to identify"

!erbali7e and report chan$es in child5s health status

valuation: 4arents able to reco$ni7e and !erbali7e chan$es in infantKchild healthrin$ infantKchild to scheduled: clinic !isits" laboratory testin$" and dia$nostic studies on time"

Documents

Acid Base Case Study